Browsing by Author "Kuteesa, Job"

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    Intra-abdominal hypertension in severe burns: prevalence, incidence and mortality in a sub-Saharan African hospital
    (International journal of burns and trauma, 2017) Mbiine, Ronald; Alenyo, Rose; Kobusingye, Olive; Kuteesa, Job; Nakanwagi, Cephas; Monka Lekuya, Hervé; Kituuka, Olivia; Galukande, Moses
    Severe burns have been shown to be a risk factor for developing intra-abdominal hypertension (IAH). Fluid resuscitation practices used in burns management further predispose patients to intra-abdominal hypertension. The mortality associated with IAH in severe burns is estimated to be more than 74.5% once organ dysfunction occurs. Despite 95% of all burns occurring in Low and Middle income countries (LMIC), there is paucity of published data on this topic in sub-Saharan Africa. Objectives: To determine the prevalence, incidence, organ dysfunction and mortality of intra-abdominal hypertension among severe burns patients. Methods: A prospective cohort study was conducted over a 6 months period in the Burns Unit of Mulago National Referral Hospital. Patients of all age groups with burns ≥25% and 20% in adults and children respectively were recruited and followed up for 7 days or until death occurred. Patients with burns older than 48 hours were excluded. The outcome variables were intra-abdominal pressure, organ dysfunction and seven day mortality. Results: Of all the 335 burns patients admitted, 64 patients met the inclusion criteria. The overall prevalence of IAH was 57.8% while the prevalence in the children and adults was 54.5% and 61.3% respectively. The incidence of IAH was 13.1 cases/100 person days with the incidence in adults being twice that of the children. The one week mortality of patients with IAH was 82.6% with the risk of dying being 3.34 (p=0.0035) and seven day survival being less than 50%. Conclusion: One in two patients with severe burns exceeding 20% or 25% in children or adults respectively developed IAH. Adults had a higher prevalence and incidence of IAH. Mortality associated with IAH exceeded 80%.
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    Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study
    (World journal of emergency surgery, 2015) Kuteesa, Job; Kituuka, Olivia; Namuguzi, Dan; Ndikuno, Cynthia; Kirunda, Samuel; Mukunya, David; Galukande, Moses
    Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy. Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively.The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.
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    Pathogenic Variants in Cancer Predisposition Genes and Prostate Cancer Risk in Men of African Ancestry
    (JCO Precision Oncology, 2020) Matejcic, Marco; Lubmawa, Alexander; Kiddu, Vicky; Masaba, Benon; Namuguzi, Dan; Mutema, George; Kuteesa, Job; Dabanja, Henry M.; Watya, Stephen
    In studies of men of European ancestry, rare pathogenic variants in DNA repair pathway genes have been shown to be associated with risk of aggressive prostate cancer. The contribution of rare coding variation to prostate cancer risk in men of African ancestry has not been established. We sequenced a panel of 19 DNA repair and cancer predisposition genes in 2,453 African American and 1,151 Ugandan cases and controls with prostate cancer. Rare variants were classified as pathogenic or putatively functionally disruptive and examined in association with prostate cancer risk and disease aggressiveness in gene and pathway-level association analyses. Pathogenic variants were found in 75 of 2,098 cases (3.6%) and 31 of 1,481 controls (2.1%; odds ratio [OR], 1.82; 95% CI, 1.19 to 2.79; P = .0044), with the association being stronger for more aggressive disease phenotypes (OR, 3.10; 95% CI, 1.54 to 6.23; P = .0022). The highest risks for aggressive disease were observed with pathogenic variants in the ATM, BRCA2, PALB2, and NBN genes, with ORs ranging from approximately 4 to 15 in the combined study sample of African American and Ugandan men. Rare, nonpathogenic, nonsynonymous variants did not have a major impact on risk of overall prostate cancer or disease aggressiveness.Rare pathogenic variants in DNA repair genes have appreciable effects on risk of aggressive prostate cancer in men of African ancestry. These findings have potential implications for panel testing and risk stratification in this high-risk population.